Sir William Osler has related how, in 1884, while visiting Virchow in Leipzig,
he received a cabled invitation to come to Philadelphia as professor of
medicine at the University of Pennsylvania.1 His reluctance to leave old
friends and ties in Montreal was resolved by tossing a four-mark piece into the
air. "Heads I go to Philadelphia, tails I stay in Montreal." Thus, the chance
turn of a coin influenced thirty-five-year-old Osler to leave his native Canada
for Philadelphia.

Here, he was asked to serve as one of four editorial writers for the popular
medical journal Medical News. In this capacity he was associated with Theophilus Parvin, an editor primarily responsible for obstetric and
gynecologic matters. Osler considered Parvin a pedantic prig, and his opinion
seemed vindicated when Parvin delivered himself of a particularly pompous and
stilted editorial on "An Uncommon Form of Vaginismus."

Osler, an inveterate prankster, had brought with him from Montreal a nom de
plume, a convenience for just such occasions. Thus, Parvin soon was delighted
to receive by letter, postmarked Montreal, a case report substantiating his
thesis, over the signature of Egerton Y. Davis, Ex. U.S. Army. This letter was
published forthwith under correspondence in the issue of the Medical News of
December 13, 1884.2 This is one document of interest relative to Osler
which Cushing did not reprint in The Life. The letter follows:

Dear Sir:

The reading of an admirably written and instructive editorial in the
Philadelphia Medical News of 24th November 24 on forms of vaginismus, has reminded me of a case which bears out, in an extraordinary way, the statements
therein contained. When in practice at Pentonville, England, I was sent for,
about 11 P.M., by a gentleman whom, on my arriving at his home I found in a
state of great perturbation, and the story he told me was briefly as follows:

At bedtime, when going to the back kitchen to see if the house was shut up, a
noise in the coachman's room attracted his attention, and, going in, he
discovered to his horror that the man was in bed with one of the maids. She
screamed, he struggled, and they rolled out of bed together and made frantic
efforts to get apart, but without success. He was a big, burly man, over six
feet, and she was a small woman, weighing not more than ninety pounds. She was
moaning and screaming, and seemed in great agony, so that after several
fruitless attempts to get them apart, he sent for me. When I arrived I found
the man standing up and supporting the woman in his arms, and it was quite
evident that his penis was tightly locked in her vagina, and any attempt to
dislodge it was accompanied by much pain on the part of both. It was, indeed,
a case "De cohesione in coitu." I applied water, and then ice, but
ineffectually, and at last sent for chloroform, a few whiffs of which sent the
woman to sleep, relaxed the spasm, and released the captive penis, which was
swollen, livid, and in a state of semi-erection, which did not go down for
several hours, and for days the organ was extremely sore. The woman recovered
rapidly and seemed none the worse.

I am sorry that I did not examine if the sphincter ani was contracted, but I
did not think of it. In this case there must have been spasm of the muscle at
the orifice, as well as higher up, for the penis seemed nipped low down, and
this contraction, I think, kept the blood retained and the organ erect. As an
instance of Iago's "beast with two backs," the picture was perfect. I have
often wondered how it was, considering with what agility the man can, under
certain circumstances, jump up, that Phineas, the son of Eleazar, was able to
thrust his javelin through the man and the Midianitish woman (vide Exodus); but
the occurrence of such cases as the above may offer a possible explanation.

Yours truly
Egerton Y. Davis
Ex. U.S. Army

Caughnawauga, Quebec,
4th December, 1884.

According to certain notes left by Osler3 concerning his alter ego,
"E.Y.D.," he made a belated effort to forestall publication of this letter. Be
that as it may, the spurious case report went into the literature and, as Osler
later bemoaned, "is often quoted."

There are numerous references to the case in the medical literature of the last
seventy-five years. Kirsch,4 in his book on The Sexual Life of Woman,
translated into English in 1910, details the case as proof of the existence of
such a condition. In 1926 Hühner,5 stated:

In particularly severe cases (of vaginismus) it has been necessary to
chloroform the female in order to release the penis from the vaginal spasm. A
case of such undue severity is reported by Davis.

More recently, Oliven6 described such a condition. He even suggests an
implied "tried and true" treatment, namely, "the insertion of a well-lubricated
thumb into the woman's rectum" to help relax the vaginal spasm. He fails to
mention whose thumb should be used.

How often have hoaxes been perpetrated in the medical literature? How careful
must one be in reading? Does the following case report by Sims, quoted in
books by Hühner and by Kelly,7 sound any less apocryphal than Osler's?

A particularly severe case (of vaginismus) is recorded by Sims as follows: A
family physician anesthetized the wife for first coitus, which then offer end
no difficulty; he continued to do this at biweekly intervals for a year, when she
became pregnant and bore a child at term. The old pain returned, however, and
it became necessary to resume the "ethereal relations."

The concept of penis captivus in the human being has a good and ancient
background.8 Brief allusions to the condition are found in Homer and
Lucretius. The first detailed accounts appear in medieval literature of the
twelfth through fourteenth centuries. All of these have religious
connotations, and the condition, when it occurred, was considered a miracle.
Separation was usually effected by prayers of the monks.

Accounts by medical writers began to appear during the seventeenth century.9
Diembroeck, the well-known seventeenth century anatomist, gives the following
account of a case:

When I was a Student at Leyden I remember there was a young Bridegroom in that
Town that being overwanton with the Bride had so hamper'd himself in her
Privities, that he could not draw his Yard forth, till Delmehorst the Physician
unty'd the Knot by casting cold Water on the Part.

A true case of de cohesione in coitu or penis captivus, such as that discussed
by Parvin and lampooned by Osler, has not been found in the modern literature.
Can time thus have changed things? Perhaps, one day, we shall "rediscover"
this condition. We are inclined, with Jacobsen,10 to doubt the occurrence
of such a catastrophe. He expresses his convictions as follows:

Has the human penis ever really been in captivity? We doubt it. We jealously
proclaim its complete freedom in a world of compromises, inhibitions and
frustrations. If the penis is not free, then all privilege is a fiction. As
Britons never shall be slaves, so the penis never shall be captured. Failure
to include such a declaration in the Atlantic Charter was a serious omission.

Other Urologic Topics

Osler's writing on urologic topics does not end with the whimsical
contribution. He also wrote on polycystic renal disease and on nephroptosis.
A single quotation from Osler on the latter subject is his best urologic
aphorism: "it is more often the mental kidney than the abdominal one that
floats."

His devilish streak was again evoked by another urologic subject. On this
occasion he reported in the Boston Medical and Surgical Journal (1903)11
a true case of Peyronie's disease. However, not content with giving the report
a Rabelaisian twist he concluded by signing it with the initials of a well-known
Philadelphia urologist, J.W. White, Jr. The latter, recognizing the true
author, countered a short time later in the same journal with a charge of
"plagiarism" detailing the tell-tale evidence of the identity of the true
author; and all of this over the initials of Osler's nom de plume (with a
misprinted T for the middle initial).

Peyronie's Disease - Strabisme du penis

Pittsburg, Feb. 14, 1903

&nbsp &nbsp Mr. Editor: An old codger of about 65 years came in one day, and, casting a
furtive glance about the room, shut the door with great deliberation. To my
question, "What is the matter?" he replied, "Squint of the cock." As I did not
take genito-urinary cases, I advised him to consult my friend Dr. Ricord, upon
which he handed me a letter, saying that his doctor had told him that I would
be most interested in his case. He then told me his story. A widower for some
years, he was anxious to marry again, but was afraid to do so on account of a
most remarkable change in his yard. When erect it curved to one side in such a
way as to form a semicircle, hopeless and useless for any practical purpose. I
call it, he said, squint of the cock. Examination showed at one side at the
root of the penis a firm induration about the size of a cherry, so placed as to
completely fill a part of one corpus cavernosum. Of course, on erection blood
filled the other corpus only, and in consequence the penis curved towards the
affected side, producing the squint of which he spoke. In the works at my
disposal, including one well-known manual of genito-urinary surgery, I could
find no account of this singular affection, but have learned when in doubt to
consult Hutchinson's Archives of Surgery, I there found a very full account
of these fibrous plaques in the corpora cavernosa, which if unilateral produce
all sorts of distortions of the penis, if bilateral, impotence. Turning to
another storehouse, the Dictionnaire Encylcopedique, under the article
"Pénis," I there found a very good description, but in addition, what was most
interesting, the statement that in about 1765, Peyronie, a French surgeon, had
described the disease as strabisme du pénis, the very term used by my old
patient. There are very good illustrations of the condition in Taylor's
Manual, but in these eponymic days old Peyronie should have the credit of
describing in a happy phrase a very unfortunate defect.

J. W. W., Jr.

The reply of J.W. White, Jr.,12 alleged author of the first letter, took the
following form:

"Peyronie's Disease - Strabisme du pénis"

Philadelphia, April 24, 1903

&nbsp &nbsp Mr. Editor: I fear J. W. W., Jr. of Pittsburg, Pa., has been listening to many
valuable "over the Scotch and soda" clinics of one of the distinguished members
of our profession, and has unconsciously become guilty of plagiarism, palming
off another's erudition for his own (see Journal, Feb. 26, 1903, p. 245).
The earmarks of plagiarism are: (I) the title (I have heard "S and S" Lectures
with such title), (II) "Codger," (III) "Yard," (IV) Hutchinson's Archives (see
a visit to the Hutchinson's Country Home by etc., etc.), (V) Dictionnaire
Encyclopédique (none such in Pittsburg). Is it possible, like everything else
that is good from Pittsburg, it is a "steal"?
&nbsp &nbsp Moreover, no one in Pittsburg would ever think of writing a sentimental letter
of such character on Valentine's Day. There is too much iron in his soul.
&nbsp &nbsp Finally, I find by Polk's that Dr. Ricord lives in Baltimore. Regretting this
further, "gold from salt water" attempts to "take in" the Yankees,
&nbsp &nbsp &nbsp &nbsp I am,
&nbsp &nbsp &nbsp &nbsp E. T. D., Jr.

Lest it be concluded that the Boston Medical and Surgical Journal was given
over to such levity, let us note that the two articles following Osler's
contribution are by George Crile and Harvey Cushing on erudite researches into
means of controlling the blood pressure and determining arterial tension in the
operating room, respectively. In the same volume there also appears one of
Osler's fine essays, "On the Educational Value of the Medical Society."

The foregoing depicts a little realized side of the character of "The Beloved
Physician." Far from demeaning that character, it is hoped that it may be
broadened and enlivened by this glimpse of Osler's sense of humor.